- 期刊
降低安寧住院病人壓傷發生率
Reducing the Incidence of Pressure Injuries in Hospice Inpatients
摘要
背景：壓傷不僅會導致末期病人疼痛、感染、嚴重甚至死亡，亦造成主要照顧者心理不捨及照顧負荷。本單位因壓傷發生率高引發家屬質疑團隊照護品質，分析原因為：護理師及主要照顧者缺少定時翻身及換尿布之提醒機制、缺乏病人拒絕翻身換尿布之因應策略、護理師對擺位姿勢及適當角度訓練不足，且缺乏角度測量工具、主要照顧者對於翻身及皮膚照護之重要性認知不足、護理指導方式過於簡略且缺乏多元護理指導工具。目的：安寧住院病人壓傷發生率由1.04%降低為0.58%、預防壓傷照護流程正確率86.5%提升至95%。解決方案：經由文獻查證及決策矩陣分析後，制定解決方案為運用手機APP設定提醒、引進尿溼感知器、設計多功能護理指導海報、擬定翻身擺位優缺點說帖、舉辦擬真教學、運用翻轉教學、創立清潔及床單平整口訣。結果：方案介入後，安寧住院病人壓傷發生率降為0.15%、預防壓傷照護流程正確率95.2%。結論：藉此專案引進多元指導方式並應用資訊設備，有效提升壓傷預防照護品質，目前尿濕感知器及多功能護理指導海報，已推廣至本院護理之家，以提供更優質的壓傷預防照護品質。
並列摘要
Background & Problems: Pressure injuries not only cause pain, infection, and death in severe cases in terminally ill patients but also psychological problems and care burden in primary caregivers. In our department, the high incidence of pressure injuries caused family members to question the care quality of our team. We determined the reasons for this to be 1) the lack of a system reminding nurses and primary caregivers to change the patient's position and diapers at fixed timings, 2) the lack of a response strategy when patients refuse to turn over and have their diapers changed, 3) nurses' insufficient training on posturing and appropriate angles, 4) the lack of tools for angle measurement, 5) primary caregivers' insufficient knowledge on changing patients' lying position and patient skin care, 6) the overly simplified nursing guidance methods, and 7) the lack of diverse health education tools. Purpose: To decrease the incidence of pressure injuries in hospice inptients from 1.04% to 0.58%. Resolution: After a literature review and decision matrix analysis, solutions such as using mobile phone apps to set reminders, introducing of urine sensors, designing multifunctional health education posters, formulating notes on the pros and cons of changing patients' lying position, conducting simulation training and flipped learning, and creating mnemonic phrases for cleanliness and flat bedsheets were introduced. Results: After introduction of the solutions, the incidence of pressure injury decreased to 0.15%. Conclusions: The introduction of various teaching methods and the application of information equipment effectively improved the preventive care quality for pressure injuries. Currently, urine sensors and multifunctional health education posters have been promoted in nursing homes under our hospital to provide better preventive care quality for pressure injuries.
參考文獻
延伸閱讀
- 廖怡惠、高美錦、陳玉芳（2021）。降低某醫學中心內科病房壓力性損傷發生率之改善方案。醫院雜誌，54(1)，1-14。https://www.airitilibrary.com/Article/Detail?DocID=P20190424001-202103-202103300016-202103300016-1-14
- 張瑛瑛、張麗銀、柯惠蓮、黎慧美、黃靜儀、何崇萍、黃淑芸（2007）。降低加護病房病人身體約束傷害率。榮總護理，24(4)，391-400。https://doi.org/10.6142/VGHN.24.4.391
- 黃瑜珮（2007）。壓力因應模式在安寧緩和病房之應用。臨床心理通訊，(36)，6-9。https://doi.org/10.29798/LCXLTX.200702.0003
- 呂欣怡、王宜婷、吳明穎、魏玉芳、闞秋萍（2019）。運用根本原因分析降低手術病人壓傷發生率。領導護理，20(4)，123-141。https://doi.org/10.29494/LN.201912_20(4).0010
- 錢靜馨（2013）。Medical resource utilization and mortality among hospitalized hospice patients〔碩士論文，高雄醫學大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0011-0309201311062300